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PubMed2004

Diagnostic yield and therapeutic implications of capsule endoscopy in obscure gastrointestinal bleeding.

AIM: The main aim of this study was to evaluate efficacy and therapeutic impact of capsule endoscopy (CE) in obscure gastrointestinal bleeding (OGIB). In addition, we evaluated the software of automatic detection of red zones (SBI, Given Imaging). PATIENTS AND METHODS: From June 2002 to June 2003, thirty-five patients with OGIB underwent capsule endoscopy after negative upper and lower digestive endoscopy. Capsule endoscopy was performed following a 12-hour fasting period and some received 2 L of PEG the night before for bowel preparation. RESULTS: CE was performed for occult (N=18) or overt (N=17) OGIB. Potentially bleeding lesions were found in 16/35 patients (45.7%). Lesions were angiodysplasias (N=8), ulcerations (N=4), tumors (N=2) and active bleeding without visible lesion (N=2). Lesions were located in gastric antrum (N=1), duodenum (N=2) and jejuno-ileum (N=13). Endoscopic (N=10), surgical (N=2) or medical (N=1) treatments were performed in 13/35 (37%). SBI was retrospectively evaluated in 24 patients with sensitivity, specificity, positive and negative predictive value of respectively 45%, 73%, 50% and 69%. CE retention during 10 days occurred in a patient with a small bowel NSAID-induced stricture. CONCLUSION: CE is a safe and effective procedure in the management of OGIB and had a therapeutic impact in more than one third of patients.

Adult↗
PubMed1999

Promising new agents for the treatment of inflammatory bowel disorders.

A groundswell of therapeutic modalities is presently sweeping through the field of inflammatory bowel disease (IBD), revolutionising the treatment and management of these disorders. At the forefront of newer agents are biological therapies, also referred to as 'biologics'. These include infliximab (cA2), CDP 571, rhIL-10, ICAM-1 antisense oligonucleotide (ISIS 2302) and opreleukin (rhIL-11). Among these, infliximab and CDP 571 are perhaps the most promising, particularly in Crohn's disease. Both are anti-TNF alpha monoclonal antibody formulations with proven efficacy at doses of 5 mg/kg for inducing remission in patients with moderate to severe refractory Crohn's disease. Infliximab is beneficial in the treatment of fistulous Crohn's disease as well. Anti-inflammatory cytokines such as rhIL-10 and opreleukin (rhIL-11) in early reports appear efficacious in Crohn's disease but not in ulcerative colitis. Budesonide, a second generation glucocorticoid, in an oral controlled ileal release capsule, is an attractive alternative to prednisone for treating active Crohn's disease of the distal ileum and proximal colon. Also available as an enema, budesonide's efficacy approximates that of prednisolone for inducing remission in active distal ulcerative colitis. Postoperative recurrences of Crohn's disease are a common clinical scenario. Recently, mesalazine, metronidazole and mercaptopurine have been re-evaluated in the postoperative setting. In the largest postoperative prophylaxis trial, mercaptopurine was superior to both placebo and mesalazine in preventing clinical, endoscopic and radiographic relapses. Finally, miscellaneous therapies such as transdermal nicotine, nicotine tartrate enemas and topical lidocaine used in pilot studies for ulcerative colitis have shown promise. Case reports of thalidomide and tacrolimus (FK 506) have reported beneficial effects in treating complicated, refractory Crohn's disease.

Animals↗
PubMed2006

Esophageal capsule endoscopy versus esophagogastroduodenoscopy for evaluating portal hypertension: a prospective comparative study of performance and tolerance.

BACKGROUND AND STUDY AIMS: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertension in cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. PATIENTS AND METHODS: In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100-mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients' preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. RESULTS: Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6 - 1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 %); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). CONCLUSIONS: Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.

Aged↗
PubMed2005

Clinical relevance of small-bowel findings detected by wireless capsule endoscopy.

OBJECTIVE: Capsule endoscopy is becoming known as a valid tool for identifying sources of obscure gastrointestinal (GI) bleeding. Fewer data are available about its clinical value for other indications. MATERIAL AND METHODS: Sixty patients (31 F, mean age 47 years, range 14-80 years) with no signs of overt GI bleeding were investigated by Given M2A video capsule for suspected small-bowel disease. The main clinical features were: iron deficient anemia (20), abdominal pain (12), chronic diarrhea (9), malabsorption and weight loss (7), Crohn's disease (CD) (5), and familial adenomatous polyposis (3). Three patients underwent wireless endoscopy for suspected GI neoplasm and one for portal thrombosis. RESULTS: Complete vision of the small bowel was achieved in 55 patients. No small-bowel lesions were identified in 17 patients, but 5 of them had gastric abnormalities. Small-bowel abnormality was found in 38 patients. Lesions compatible with CD were found in 14 patients, diffuse or patchy enteropathy in 7 and polyps in 6. Actively bleeding lesions were detected in 6 patients and potential bleeding sources in 5. Capsule endoscopy had an overall diagnostic yield of 62%. In particular, three small-bowel malignancies were detected and 9 patients received a better definition of their already-known pathology. However, further endoscopies were needed in 10 patients to obtain a diagnosis. One patient, diagnosed with ileal CD, underwent surgery, as the capsule remained trapped in a stricture. CONCLUSIONS: Wireless endoscopy effectively visualizes small-bowel abnormalities even though more accurate selection of the patients is needed in order to optimize its diagnostic efficacy.

Abdominal Pain↗
PubMed2004

Ulcers and gastritis.

Significant advances continue to be made in the area of gastritis and ulcer disease. Studies to identify the most appropriate use of capsule endoscopy have now confirmed that it is superior to other methods for identifying small-bowel mucosal pathology and sites of obscure gastrointestinal bleeding. It has increasingly been recognized that the complications of ulcer disease are secondary to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to interactions between NSAIDs and Helicobacter pylori. Effective prophylaxis for NSAID ulcers in H. pylori-negative individuals continues to be a challenge, as it has become clear that conclusions from studies focusing on "endoscopic ulcers" in patients whose H. pylori status was unknown provided a false sense of security. The concept of multifocal atrophic gastritis has been challenged. The precursor lesion to gastric cancer now appears to be a sheet of pseudopyloric metaplasia advancing into the gastric body with islands of intestinal metaplasia embedded within it. Multifactorial models such as those proposed for understanding periodontal disease, including the organism, environmental factors, and host factors, appear particularly applicable to understanding the pathogenesis of H. pylori-associated gastric cancer.

Endoscopy, Gastrointestinal↗
PubMed1980

Angiography and pancreatoductography in resectable carcinoma of the pancreas.

Angiography and pancreatoductography were performed in 18 patients with resectable carcinoma of the pancreas. The presence or absence of vascular and ductal tumor involvement was evaluated. Accurate diagnosis was obtained in 83 per cent at pancreatoductography alone, in 66 per cent at angiography alone, while combination of the methods resulted in 94 per cent accuracy. Tumor involvement of the capsule and secretion stagnation in the distal part of the pancreas are of importance for the surgical management and the survival after resection. An improved result after surgery may be obtained by combined evaluation of the vascular and ductal morphology as demonstrated at preoperative radiography.

Celiac Artery↗
PubMed2005

Minimally invasive endoscopic reconstruction technique of acute AC-joint dislocations: a cadaver study.

The treatment of acute Rockwood type III AC-joint dislocations is controversial. Problems related to open surgery are soft tissue healing, residual instability and the necessity of hardware removal. After non-operative therapy the cosmetic result may be problematic and in some cases symptomatic instabilities occur. The goal of the present cadaver study was to develop a new, minimally invasive technique for acute AC-joint reconstructions and to analyse its potential risk for neurovascular injuries. The surgical technique was based on an arthroscopically assisted reconstruction of the coracoclavicular ligaments with a suture anchor (Arthrex, Naples, FL, USA) and a supplemental stabilization of the AC-joint capsule with a suture cerclage (Fibre Wire 2, Arthrex) performed on ten cadaveric shoulder specimens. After surgery all specimens were dissected to analyse the anatomy of the coracoclavicular ligament complex, the position of anchors and sutures and to measure the distance to the neurovascular structures at risk. The supraspinatus muscle was never injured by the Neviaser approach. The insertion of the suture anchors never failed, resulting in a secure and reproducible anchor position. The mean distance between the coracoid and suprascapular nerve was 1.8 cm (1.5-2.2), between the coracoid and the suprascapular artery 1.5 cm (1.3-1.9). These structures were never injured. The resulting force vector of the suture located between the anchor and the drill hole was close to the anatomic force vector of the coracoclavicular ligament complex. The suture cerclage was always correctly positioned. The presented technique is at minimal risk for the surrounding neurovascular structures and allows for a minimally invasive and anatomically correct reconstruction of the AC-joint. Further biomechanical analysis is needed to evaluate the strength of the reconstruction technique. The proposed technique might be a reasonable alternative to existing invasive techniques of open reconstruction of acute type III AC-joint dislocations in high-demand patients.

Arthroscopy↗
PubMed2006

PillCam ESO in esophageal studies: improved diagnostic yield of 14 frames per second (fps) compared with 4 fps.

BACKGROUND AND STUDY AIM: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. PATIENTS AND METHODS: 42 patients with GERD symptoms and eight patients with a history of Barrett's esophagus had an esophagogastroduodenoscopy (EGD). All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4-fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14-fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett's esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. RESULTS: The 4-fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 %) and 6/8 cases of Barrett's esophagus (sensitivity 75 %). The 14-fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett's esophagus (sensitivity 100 %). The total diagnostic miss rate in the 4-fps group was 5/27 (18 %) whereas the diagnostic miss rate in the 14-fps group was 0/23 (0 %) P < 0.02). The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 %) in the 4-fps group and in 20/25 patients (80 %) in the 14-fps group ( P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 %) by the 4-fps device and in 19/25 (76 %) by the 14-fps device ( P < 0.01). The superiority of the 14-fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14-fps PillCam this means one image transmitted per 3-cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. CONCLUSIONS: Capsule endoscopy using the 14-fps PillCam ESO showed a greater sensitivity than that of the 4-fps device for identifying GERD. The 14-fps PillCam ESO was statistically superior to the 4-fps device in visualizing the opening of the UES and the entirety of the esophagus.

Endoscopes, Gastrointestinal↗
PubMed2003

Pharmacokinetics of omeprazole in patients with liver cirrhosis and extrahepatic portal venous obstruction.

Omeprazole is frequently used in patients with cirrhosis of the liver to treat peptic ulcer disease. It is also used for the healing of mucosal lesions after endoscopic sclerotherapy of esophageal varices in cirrhosis and extraheptic portal vein obstruction (EHPVO). This study was carried out with the aim of determining the pharmacokinetics of omeprazole in different degrees of liver cirrhosis and in patients with EHPVO, compared with healthy volunteers. Ten healthy volunteers, 30 patients with cirrhosis of the liver, divided into 3 groups of 10 depending on severity (according to Child-Pugh classification A, B and C) and ten patients with EHPVO participated in the study. The subjects received an omeprazole 20 mg capsule after an overnight fast. Blood samples were collected at 0, 0.5, 1, 1.5, 2, 2.5, 3, 6, 9 and 24 h after drug administration. Omeprazole level in plasma was estimated by reverse-phase high performance liquid chromatography (HPLC). The elimination half-life was significantly (p < 0.05) increased to 2.38 +/- 0.16, 3.26 +/- 0,12, 3.58 +/- 0.31 and 2.59 +/- 0.22 h in patients with different grades of cirrhosis (A, B and C) and also in patients with EHPVO, respectively, compared with 1.054 + 0.10 h in healthy volunteers. A similar significant increase (p < 0.05) was observed in the AUC(0alpha), while C(max) was significantly increased to 400.40 +/- 27.89 and 602 +/- 55.13 ng/ml in only grade C cirrhosis patients and EHPVO patients, compared with 303.5 +/- 36.42 ng/ml in healthy volunteers. No significant difference was observed in T(max). It was concluded that the metabolism of omeprazole was significantly impaired in both liver cirrhosis and EHPVO in comparison with healthy volunteers.

Administration, Oral↗
PubMed1975

[Sulpiride in the management of gastroduodenal ulcers. A comparative double-blind study].

UNLABELLED: Sulpiride (Dogmatil) is a new type of drug acting on the hypothalamus resulting in a physiological increase in amplitude and frequency of gastric motor activity, reduction of signs of abnormal activity and pyloric spasm and an increase in the rate of gastric emptying. Gastric secretion is for all practical purposes unchanged, either in quantity or in acid content. The effects of Sulpiride on the duodenum are similar through some hypotony may be seen. The motor effects of Sulpiride do not relate to its effectiveness in treatment of gastroduodenal ulceration and experiments have shown that this activity can be explained by the reduction of capillary vaso-constriction in local blood circulation at the site of experimentally-induced ulcers, producing a vaso-dilatation assisting healing. This study objectively evaluates the activity of Sulpiride in gastro-duodenal ulcers. 64 patients were studied under strict criteria and acute hemorragic, multiple or abnormally situated ulcers as well as those associated with other infections were eliminated. The dosage was uniform, two ampoules daily of 100 mgs i.m. of Sulpiride or placebo for 12 days, followed by 3 capsules daily of 50 mgs of Sulpiride or placebo for 48 days. No other treatment was given and no dietery restrictions were imposed, though alcohol and Aspirin and similar drugs were restricted. Of the 64 patients, 26 (18 men, 8 women, aged from 21 to 80 years) had gastric ulcers, 14 were treated with Sulpiride, 12 with placebo. 38 cases (29 men and 9 women, aged between 21 and 70 years) had duodenal ulcers, 18 were treated with Sulpiride, 20 with placebo. Full clinical, biological, radiological and endoscopic tests were carried out and a full questionnaire was completed. RESULTS: Highly significant differences in favour of Sulpiride were shown in both gastric and duodenal ulcer cases, maximum from the 20th day than less significative radiological results appeared. Similar remarks apply to endoscopic results. Sulpiride was extremely well tolerated, though amenorrhea (1) or galactorrhea (2) were noted without causing inconvenience to the patient. The author believes that the clinical effectiveness of Sulpiride in the treatment of gastro-duodenal ulcers is incontestable showing maximum results in ambulatory patients from the 20th day. A large number of patients would probably have produced statistically significant differences in radiological and endoscopic evidence of healing.

Adult↗
PubMed2003

[Capsule endoscopy in small bowel diagnostics].

INTRODUCTION: Capsule endoscopy allows for the first time total and painless imaging of the entire small bowel. The main indication for capsule endoscopy is obscure gastrointestinal bleeding which not explained by upper gastrointestinal endoscopy, colonoscopy and small bowel radiology. Capsule endoscopy has also the capacity to detect tiny small bowel manifestations of other pathologic conditions such as Crohns's disease. METHOD AND AIMS: The GivenM2A wireless capsule endoscopy system for investigation of the whole small bowel was developed in the late 1990s. The small size swallowable capsule contains a miniature video camera, four light sources, two batteries and a radiotransmitter. This paper describes the capsule endoscopy examination method and summerizes the initial achievements from two medical centres, the Petz Aladár County and Teaching Hospital and from the Malmö University Hospital. RESULTS: 42 patients were included of whom 37 patients with obscure gastrointestinal bleeding. Pathological small bowel findings were detected in 62% of the all cases, and the source of bleeding was identified by the M2A capsule in 56.7% of the chronic bleeders. The diagnostic sensitivity of the capsule endoscopy in obscure gastrointestinal bleedings was superior both to that of push enteroscopy, 19%, and enterography, 6.7%. The capsule endoscopy was well tolerated and accepted by the patients. CONCLUSIONS: This new diagnostic method is promising mainly for detection of a small bowel source of obscure bleedings. The availability of the method in major gastroenterological centers is strongly recommended.

Adolescent↗
PubMed1977

Evaluation of Duogastrome (carbenoxolone sodium) for the treatment of duodenal ulcer: a multicentre study.

A double-blind study was carried out in 152 Canadian patients, 76 given Duogastrone (carbenoxolone sodium) capsules, 50 mg qid, and 76 given placebo capsules qid for 6 weeks. All patients had a duodenal ulcer diagnosed by roentgenography or endoscopy, or both. Evaluation of the efficacy of Duogastrone therapy was based on data from the 119 patients (59 treated with Duogastrone and 60 with placebo) who met all the strict requirements of the protocol. The ulcers healed completely in 75% (44/59) of the patients treated with Duogastrone and in 48% (29/60) of those treated with placebo; this difference is significant (P less than 0.01). The proportions were similar in the patients assessed only endoscopically: 76% (32/42) and 55% (26/47), respectively. In the group treated with Duogastrone the following side effects were noted: weight gain, edema, mild hypokalemia, increase in blood pressure and slight increases in serum concentrations of lactic dehydrogenase and alkaline phosphatase. None was serious. However, close clinical monitoring by weekly visits to their physician is recommended for every patient undergoing Duogastrone therapy, at least during the 1st month.

Adolescent↗
PubMed2005

[Octreotide in the treatment of angiodysplasia in patients with advanced chronic renal failure].

Angiodysplasia is an important cause of gastrointestinal bleeding in patients with chronic renal failure. Octreotide, a long-acting synthetic somatostatin analogue that reduces splachnic blood flow have been used to treat esophageal varicose hemorrhage, but its efficacy for bleeding vascular ecstasies is awaiting support. We present three patients with chronic renal failure (two with diabetic nephropaty and the third with mesangiocapilar glomerulonephritis and hepatic cirrosis), seric creatinine 3-4,5 mg/dl, and recurrent gastrointestinal bleeding due to diffuse angiodysplasia and vascular ecstasies, diagnosed by oral endoscopy, colonoscopy and video capsule. They all were treated with octreotide, administered subcutanesly 0.1 mg twice a day for six months, with significantly decreased blood requirements in all of them, as well as the occurrence of bleeding episodes. It was well tolerated and none side-effects occurred in any subject. In our experience, octreotide is an effective and safe drug in bleeding angiodysplasia and ecstasies vascular of the gastrointestinal tract in patients with chronic renal failure, and it may be a good option especially in patients who are not candidates for surgery or endoscopic treatment due to inaccessible sites, spread of the lesion, old age and/or concomitant disorders.

Adult↗
PubMed1996

Computer-controlled monitoring of bladder pressure in the prevention of 'TUR syndrome': a randomized study of 53 cases.

OBJECTIVE: To evaluate the performance of a computer-controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome. PATIENTS AND METHODS: The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0-500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood. RESULTS: When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings. CONCLUSION: The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.

Adenoma↗
PubMed2005

Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial.

BACKGROUND: Capsule endoscopy (CE) is a new modality for obscure digestive bleeding (OBD), but little is known about its influence on management and outcome. PATIENTS AND METHODS: Fifty-six patients (male/female 26/30; mean age 63 yr) with ODB, and negative upper and lower gastrointestinal (GI) endoscopy were included in this multicenter study. The diagnostic yield of CE was compared to three other tests (OT: push enteroscopy, enteroclysis, angiography), and patients were followed up for at least 6 months. Parameters were analyzed that led to major management changes such as surgical or endoscopic intervention or specific medical therapy, as well as their correlation to further bleeding. RESULTS: CE had a diagnostic yield higher than OT (68% vs 38%). Major management changes and an improvement in bleeding activity were observed in 21 and 44 patients, respectively. The number and type of positive findings on CE were associated with significant management changes (p < 0.05). The number of positive findings detected by CE as well as by OT correlated with further bleeding episodes (p < 0.05). However, clinical parameters (lowest hemoglobin (Hb) value, number of blood transfusions) were also significantly associated with outcome. Diagnoses of specific diseases (tumor, Crohn, NSAID ulcer) by CE led to a favorable outcome in 64% of cases, whereas negative CE cases were associated with no further bleeding in 80%. CONCLUSION: CE helps with management decisions and can replace other more complex and risky standard tests. Nevertheless, clinical parameters are equally important for predicting further bleeding and should also be used to decide on further management.

Adolescent↗
PubMed2003

Gastric emptying rates in idiopathic dyspepsia with and without "hunger pain".

It has been previously observed that in dyspeptic patients with "hunger pain", that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between "hunger pain" and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without "hunger pain" were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without "hunger pain", and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with "hunger pain", and significantly lower in the patients without "hunger pain", than in the normal control subjects. In idiopathic dyspepsia with and without "hunger pain" there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

Abdominal Pain↗
PubMed2005

Autoimmune pancreatitis: radiologic findings in 20 patients.

BACKGROUND: Autoimmune pancreatitis is a new clinical entity that is characterized by peculiar histopathologic and laboratory findings and by a dramatic clinical response to corticosteroid therapy. We evaluated the radiologic findings of autoimmune pancreatitis. METHODS: Computed tomographic, magnetic resonance imaging, endoscopic retrograde cholangiopancreatographic, and ultrasonographic findings of 20 patients with autoimmune pancreatitis in our hospital between November 2000 and December 2003 were retrospectively reviewed regarding changes and ancillary findings in the pancreatic parenchyma, the main pancreatic duct, peripancreatic vessels, and distal common bile duct. In addition, follow-up images were reviewed for changes in any abnormality seen on the initial examinations. RESULTS: Pancreatic parenchymal enlargement was invariably seen that was diffuse (n = 19) or focal (n = 1), with homogeneous contrast enhancement on computed tomography (n = 20) and magnetic resonance imaging (n = 15). Capsule-like rim enhancement was seen in six patients. There was focal (n = 18) or diffuse (n = 2) narrowing of the main pancreatic duct and it was usually multifocal (n = 17) in the former. Narrowing of the peripancreatic veins was seen in 14 patients. There was tapered (n = 15) or abrupt (n = 3) narrowing of the distal common bile duct in 18 patients, with contrast enhancement of the narrowed segment in eight. Invariably, changes in the pancreatic parenchyma, main pancreatic duct, peripancreatic vessels, and common bile duct were normalized on follow-up studies after steroid therapy. CONCLUSION: In this series, common radiologic findings of autoimmune pancreatitis were (a) diffuse pancreas enlargement, (b) multifocal narrowing of the main pancreatic duct, (c) narrowing of peripancreatic veins, and (d) tapered narrowing of the distal common bile duct with frequent contrast enhancement. These findings were usually reversible with steroid therapy.

Adult↗
PubMed2006

Small bowel exploration by wireless capsule endoscopy: results from 314 procedures.

OBJECTIVES: To assess the diagnostic efficiency of capsule endoscopy in a large group of patients with different indications, to weigh the reliability of the procedure for excluding small bowel lesions, and to identify factors associated with the likelihood of obtaining a definitive diagnosis. METHODS: Three hundred four consecutive patients (141 female, mean age 55 years, range 12-91 years) underwent capsule endoscopy in two different Gastroenterology Units, for a total of 314 procedures, and were followed-up for a median period of 15 months. Referrals were obscure occult/overt gastrointestinal bleeding (203 patients), suspected small bowel disease (74), gastrointestinal polyposis (18), suspected/previous intestinal or endocrine malignancies (13), previously diagnosed intestinal lymphangectasia (3), and vascular abnormalities (3). RESULTS: Adequate visualization of the small bowel was obtained in 96% of patients, although the capsule did not visualize cecum in 20% of cases. Non-natural excretion of the capsule was observed in 4 patients, all of whom underwent laparotomy for intestinal stenosis. Diagnostic yields were 58% for obscure gastrointestinal bleeding and 31% for patients with suspected small bowel disease. Capsule endoscopy was able to rule out small bowel disease in 14% of patients, and a definitive diagnosis was achieved in 65% of patients. The only parameter associated with the likelihood of reaching a conclusive diagnosis was the indication to the procedure (overall chi-square 13.5, P = .004). CONCLUSIONS: Capsule endoscopy represents a reliable tool for verifying the state of the small bowel. Accurate selection of indications and critical evaluation of the results are essential to fully exploit this procedure.

Adolescent↗